Fourth branchial pouch sinus — an unusually late initial presentation

Abstract

Objective Here we present an unusual case of a male patient with 4th branchial pouch sinus with an initial presentation of pseudothyroiditis at an unusually late age of 20 years.Method Case report and a review of the world literature concerning 4th branchial pouch sinus is presented.Result The patient was diagnosed by radiology and endoscopy and treated surgically. Histopathology revealed chronic infl ammatory changes, which pointed towards recurrent sub clinical low-grade infl ammations over the years keeping the condition occult till 20 years of age. ConclusionAccording to available literature it almost always presents in the fi rst decade of life when it might be misdiagnosed. However our report shows it may also exist with sub clinical infl ammations or infections and present at a much later stage in life, when the possibility of such a sinus shouldn't be ruled out on the basis of lack of history of recurrent neck infl ammations.

A Rare Case of Right Fourth Branchial Fistula: A Diagnostic Challenge

“…Fourth branchial anomalies typically manifest in the first decade of life and usually have a long history of recurrent neck lesions which are refractory to treatment [ 9 ]. Stadler et al reported a case of recurrent neck infections with long-term misdiagnosis for 24 years before the correct diagnosis of fourth branchial cleft anomaly was made [ 10 ].…”

Efficacy of fine-needle aspiration cytology for a thyroid abscess in children: Two case reports

“…Acute suppurative thyroiditis (AST), an inflammatory disease of the thyroid gland, is extremely rare in adults, since they typically exhibit a strong resistance to local infection ( 1 ). Thyroid abscesses are more likely to occur in children in instances of congenital anomaly ( 2 ). The majority of AST cases are caused by Gram-positive Streptococcus species ( 3 ).…”